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DACVIM Literature 2018-2023 > Neurology > Flashcards

Neurology Flashcards

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1
Q

What is chiari-like malformation?

What is syringomyelia?

What are at least three common CS?

A

Malformation of the skull and cranial vertebrae –> overcrowding of brain, subsequent partial herniation –> compression of brain stem and cervical spinal cord, CSF obstruction, syringomyelia (fluid filled cavity within the spinal cord parenchyma)

CS:
**Note - can be painful WITHOUT syringomyelia
–Can be asymptomatic, or vague CS that overlap with other diseases
–Yelping
–Phantom scratching
–Neck pain (decr mobility, head shy, etc)
–Facial pruritus, rubbing

Less common:
–Seizures
–Air licking
–Vestibular, other CN deficits, proprioceptive deficits
–Pain while defecating

JVIM 2019 Rusbridge

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2
Q

True or False: CKCS with more brachycephalic conformation are at greater risk for chiari-like malformation.

A

True

JVIM 2020

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3
Q

Complications of ventriculoperitoneal shunts to treat hydrocephalus:
–At least 4 complications
–More likely in dogs or cats?
–Usually occur in what time frame post op?
–Proportion that are surgically fixable?

A

Shunt obst, disconnection, kink, excessive shunting, pain, infxn
Coiling of shunt into SQ tissues – most common complication in cats, no dogs
**Note – sz are NOT a complication of shunts!

Cats > dogs

Within 6mo

Half

JVIM 2019 Schmidt
JVIM 2019 Gradner
JVIM 2020 Farke

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4
Q

Vertebral malformations:
–What dog breed is most at risk?
–Are neuro deficits common or uncommon? What two imaging findings are CS associated with?
–Do symptomatic dogs respond best to med, sx, or either?

A

Pug > other brachycephalic breeds

Uncommon. Assoc with:
–More severe kyphosis
–FEWER hemivertibrae

Sx! One study found ALL med dogs had progression of signs

JVIM 2019 De Decker
JAVMA 2018 Wyatt

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5
Q

Lafora disease:
–What is it?
–Signalment?
–CS?
–Impact on lifespan?

A

Autosomal recessive neuro storage disease

Middle aged beagles

Starts with generalized sz, then decr vision/hearing/learned tricks, staring, photosensitivity

Can still reach normal lifespan

JVIM 2021 Flegel

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6
Q

Chihuahuas with persistent fontanelles:
More numerous/larger associated with what three other malformations?

A

Chiari
Syringomyelia
Ventriculomegaly

**Also, tended to be smaller dogs

JVIM 2021 Kiviranta

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7
Q

Two 6wk GSD puppies from the same litter with course, side to side tremors affecting their head and trunk. Tremors interfere with walking but go away at rest. They have been shaky since birth but the breeder thought they would grow out of it. The siblings and parents are normal.

–Top ddx?
–Mode of inheritance?
–Basic mechanism?
–Progression?

A

Hypomyelinating leukodystrophy (“shaking puppy syndrome”) in GSDs. Autosomal recessive. Abnormal CNS myelination.

Puppies are often euth’d. If not, tremors may improve until 6-7mo old. Adults will have severe PL ataxia.

JVIM 2021 Quitt

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8
Q

Two 3mo old Bouvier des Ardennes siblings (look like a big/tall Westie). Both have intention tremors and more recent onset generalized hypermetric ataxia. One puppy is considerably more affected than the other. The parents and other siblings are normal.

–Top ddx?
–Cause?
–One other breed that gets this?
–Prognosis?

A

Spinocerebellar ataxia

KCNJ10 homozygous mutant (autosomal recessive inheritance) –> cerebellar spongy degeneration, demyelinating myelopathy

Belgian malinois

Poor – likely to progress to nonambulatory status before 1yr old

JVIM 2023 Stee

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9
Q

What is caused by LAMA2 gene deletion?

Prognosis?

A

Congenital muscular dystrophy (progressive weakness and loss of muscle mass; can confirm with bx, genetic analysis)

Progressive disease w/ no specific tx. Poor px.

JVIM 2021 Shelton

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10
Q

What is caused by SCN9A variant?

A

Congenital insensitivity to pain

Autosomal recessive

JVIM 2023 Gutierrez-Quintana

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11
Q

True or False: Idiopathic epilepsy is the most common cause of seizures in cats <1yr old.

A

False – structural disease (FIP, congenital malformation, trauma)

JAVMA 2018 Qahwash

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12
Q

When is ammonia level NOT diagnostically helpful in a cat with seizures?
A) Preictal
B) Postictal
C) In between seizures

A

B - can have transient hyperammonemia WITHOUT liver dysfunction, goes back to normal within a couple hours

JFMS 2021 Nilsson

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13
Q

In cats, which are more commonly associated with recurrent seizures?
A) Younger
B) Older
C) Idiopathic epilepsy
D) Structural brain disease

A

B, D

JFMS 2019 Hazenfratz
JVIM 2020 O’Neill

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14
Q

What is high HMGB1 associated with?
A) Idiopathic epilepsy
B) Immune mediated meningoencephalitis
C) Protozoal cause of meningoencephalitis
D) Intracranial neoplasia
E) Canine cognitive dysfunction

A

A

JVIM 2020 Koo

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15
Q

Are definable seizure triggers (stress, sleep deprivation, weather, hormones) more common for focal or generalized seizures?

A

Focal
JVIM 2019 Forsgard

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16
Q

Dogs with seizures triggered by eating:
–Possible overrepresented breed?
–More common with idiopathic epilepsy or structural brain disease?
–Effect of changing eating habits (food, bowls, meal size, etc)?

A

Lab
Idiopathic epilepsy
None – need antiseizure drugs

JVIM 2020 Brocal

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17
Q

Efficacy of the following novel treatments for refractory epilepsy (great, modest/equivocal, worsening)

Medium chain TG
Telmisartan
CBD

A

All modest/equivocal

JVIM 2020 Berk
JAVMA 2022 Hanael
JAVMA 2019 McGrath

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18
Q

Which antiepileptic drug should be avoided in cats and why?

A

Bromide –> asthma

JFMS 2018

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19
Q

Which two causes of seizure are less responsive to miazolam CRI?
A) Idiopathic epilepsy
B) Structural epilepsy
C) Reactive seizure
D) Status epilepticus

Which midaz bolus route works faster: intranasal or IV? Does either work better?

A

C, D

Intranasal works faster unless IVC is already in place. Comparable efficacy.

JVIM 2020 Bray
JVIM 2019 Charalambous

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20
Q

In dogs with status epilepticus who survive to discharge, what two factors are associated with recurrence of status epilepticus?

A

Prior drug resistant epilepsy
Predominance of a focal seizure phenotype

JVIM 2022 Fentem

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21
Q

Which is true about TDERM phenobarb in cats? Keppra?
A) No bioavailability
B) Variable bioavailability, dosing is trial/error with therapeutic drug monitoring
C) Consistent bioavailability but unable to reach therapeutic dose target
D) Consistent bioavailability and able to reach therapeutic dose target

A

Pheno - B) variable, trial/error guided by therapeutic drug monitoring

Keppra - D) consistently reaches target goal (from human lit – not established for cats)

JFMS 2019 Heller
JVIM 2019 Smith

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22
Q

How do concurrent phenobarb and/or zonisamide affect the pharmacokinetics of keppra?
A) No effect – stable pharmacokinetics
B) Zonisamide causes variable keppra pharmacokinetics, but pheno does not
C) Pheno causes variable keppra pharmacokinetics, but zonisamide does not
D) They both cause variable keppra pharmacokinetics
E) Unclear – highly variable pharmacokinetics even with keppra monotherapy

A

C – although pharmacokinetics are variable with keppra monotherapy, pheno makes it worse

JVIM 2018 Munana

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23
Q

Why does midaz have diminishing returns for cluster seizures?

When used with midaz, provides better control of clusters, status epilepticus:
Pheno IV
Keppra rectal

A

Internalizatoin of GABA-A receptors

Keppra - 94% response rate vs 48% pheno

JVIM 2019 Cagnotti

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24
Q

Which is associated with older cats, stable to improving neuro signs, lateralizing, nonpainful?
A) IVDD
B) Spinal empyema
C) Spinal LSA
D) Spinal MCT
E) Ischemic myelopathy

Which spinal segment does this most commonly affect?

A

E, C6-T2

JFMS 2020 Mella

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25
12yr MN mixed breed dog with moderate ambulatory proprioceptive ataxia, tetraparesis, CP deficits x4. He has R sided Horner's. --Neurolocalization? --Most likely cause?
C2-C5. Horner's is unreliable to determine lateralization. Noncompressive intraparencymal disease (probably FCE) Summary: cervical myelopathy + Horners --> usually FCE JVIM 2023 Murthy
26
Wobbler's: --What is the technical term for it? --Age of onset and difference in etiology for large vs giant breed dogs?
Cervical spondylomyopathy: caused by any combination of vertebral canal stenosis, movement assoc compression, etc Large breed: median 7yrs, due to intervertebral disc compression Giant breed: median 2-3yrs (but can be puppies), articular process proliferation JVIM 2019 Bonelli
27
Which on this list is the most sensitive test for discospondylitis in dogs with myelopathy? A) Back pain B) Fever C) Neutrophilia D) Hyperglobulinemia E) CRP
E) CRP JVIN 2020 Trub
28
Which is most common in cats with discospondylitis? A) Back pain B) Fever C) Neuro deficits D) Positive intradisc FNA culture E) Positive blood culture Treatment and prognosis?
A) Back pain (all cats in N = 17 study) Fever and positive culture were uncommon Tx: Clavamox or cephalosporine, median 3mo; plus NSAIDs +/- gaba Px: Good for most (neuro function, pain control) JFMS 2022 Gomes
29
Which diseases are associated with the following gene mutations? COLQ KCNJ10 LAMA2 MTRM13/SBF2 NDRG1 SCN9A SOD1
COLQ Congenital MG in golden retrievers; progressive muscle weakness (ME not a feature), most do horrible KCNJ10 Spinocerebellar ataxia in Bouvier des Ardennes and Malinois LAMA2 Congenital muscular dystrophy MTRM13/SBF2 Demyelinating polyneuropathy in mini schnauzers, usually stable disease with good px NDRG1 Alaskan Malamute polyneuropathy, can cause tongue atrophy SCN9a Congenital insensitivity to pain SOD1 Degenerative myelopathy **Note - most (all?) of these are autosomal recessive
30
Surgery is consistently helpful for: A) Thoracic vertebral canal stenosis in cats B) Thoracolumbar vertebral instability C) Lumbosacral stenosis in dogs
B (pugs, articular process issue) and C Hit and miss with A JFMS 2020 Gillespie JAVMA 2022 Tanoue JSAP 2022 Aikawa
31
Define the following: Schiff-Sherrington Spinal shock Central cord syndrome
Schiff-Sherrington: severe T2-L7 lesion with damage to the propriospinal tract --> unable to inhibit forelimb extensors. Normal gait, but extensor rigidity TLs when in lateral. Spinal shock: T3-L3, severe injury --> interruption in descending motor tracts and local reflex changes --> can look like L4-S3 myelopathy (but not quite as flaccid), commonly have a reduced withdrawal Central cord syndrome: gray matter spinal lesion, LMN signs TLs (floppy) and UMN signs PLs (incr tone); classically C6-T2 but one paper found more commonly C3-C5 JVIM 2022 McBride JAVMA 2022 Ros
32
Constrictive myelopathy: --Median age, breed? --Does this tend to occur with or without other concurrent myelopathies? --How common is fecal incontinence?
Middle aged pugs Usually other concurrent myelopathies Progressive disease -- 80% become fecally incontinent JVIM 2023 Wachowiak
33
Nontraumatic spinal cord hemorrhage: --Top three causes? Px with these? --Which is more important for px: etiology or severity of neuro signs?
Idiopathic >> Angiostrongylus vasorum > SRMA Px was generally good to excellent. Etiology more important than severity of signs. West
34
What percentage of dogs recover from IVDD with med vs sx: --Spinal pain, ambulatory paraparesis --Nonambulatory paraparesis --Paraplegia, deep pain positive --Paraplegia, deep pain neg
--Spinal pain, ambulatory paraparesis: 80%/99% --Nonambulatory paraparesis: 81/93 --Paraplegia, deep pain positive: 60/93 --Paraplegia, deep pain neg: 21/61 **Note -- less complete recovery with med vs sx mgmt JVIM 2022 Olby
35
True or False: NSAIDs and pred are equally reasonable for acute and chronic IVDD.
False Acute - use NSAIDs Chronic - use pred JVIM 2022 Olby
36
Four abx classes that can cross the BBB?
'Amphenicols TMS Tetracyclines (somewhat) Fluoroquinolones (somewhat)
37
1yr FS fawn colored pug. Routine wellness exam reveals multifocal spinal pain, reduced menace, and mild left sided paw placement deficits. What ddx are you worried about? What are the CS of fulminant disease?
Early signs of necrotizing meningoencephalitis Median onset of fulminant disease 1.5-2.5yrs old CS = rapidly progressive sz, circling, visual deficits, behavior change JVIM 2022 Windsor
38
What three factors are associated with post-MUO epilepsy? (1 signalment, 1 CS, 1 MRI) How does this affect px?
Younger, with sz early in MUO, lesions in hippocampus Shorter survival JVIM 2020 Kaczmarska
39
High neutrophil:lymphocyte ratio can NOT differentiate MUO from which of the following? A) Normal dogs B) Idiopathic epilepsy C) Intracranial neoplasia D) Hydrocephalus
C) Intracranial neoplasia So, high N:L --> ddx MUO or cancer JVIM 2022 Park
40
What proportion of MUO dogs overall have seizures? Those with BBB dysfunction?
20% 70% JVIM 2022 Hanael
41
CSF collection: Which should be sampled for diagnostic accuracy? A) Cerebellomedullary cistern B) Lumbar subarachnoid space C) Both D) Either SRMA: Which informs likelihood of relapse? A) CSF nucleated cell count B) Treatment protocol C) Both D) Neither
C) Sample both sites; either is equally likely to be normal vs diagnostic, so gotta do both. Exception - TL myelopathy, may be fine to do lumbar only. A) CSF nucleated cell count JVIM 2019 Lau JAVMA 2019 Carletti JVIM 2020 Lampe
42
Dogs with SRMA frequently have concurrent cardiomyopathy. What is the most common finding on echo? Do cardiac abnormalities typically resolve with tx for SRMA?
Spontaneous contrast Yes -- within 2 weeks JSAP 2019 Spence
43
What is the difference between intracranial abscess vs empyema? Do cats with either of these diseases do better with sx or med management?
Abscess - intra-axial collection of pus Empyema - pus within a preexisting anatomical cavity MST trended longer for surgical but did not reach statistical significance, and either sx or med can do quite well JFMS 2019 Martin
44
True or False: CS of bacterial meningitis/meningoencephalitis in dogs is variable. Px with treatment is generally good.
True JVIM 2023 Rawson
45
Intracranial surgery: When are complications most common? A) Immediately post op B) Within a week post op C) Long term How often are they life threatening?
B) Half within a week (neuro deficits, sz, anemia, asp pneumonia) C) 40% long term (neuro deficits, sz) A) One third immediate post op (hypotension, anemia) Usually not life threatening JAVMA 2022 Morton
46
CNS histiocytic sarcoma: --For which breed is this always disseminated, rather than a primary tumor? --What is the utility of CSF and serum Neut:Lymph ratio? (Dfdx? Local vs disseminated HS?) --Px depending on local vs disseminated dz and tx?
--Rottie --Dfdx but not tumor subtype --Px best with primary tumor and definitive RT (6 wks) but overall still poor JVIM 2020 Toyoda
47
True or False: Altered consciousness is highly sensitive for brain herniation.
False JFMS 2020 Kouno
48
Pituitary apoplexy in dogs: --What is it? --Top 3 PE findings? --Treatment? How does this affect px? --True or False: Dogs almost always present with rapidly progressive HAC signs.
Bleed or infarct in pituitary macroadenoma Gait/posture change, mentation change, abnormal CN exam Radiation better MST (2.6yrs) vs medical management (5mo) False -- 40% had no endocrinopathy signs at all JVIM 2023 Woelfel
49
Which is a sensitive and specific predictor of incr intracranial pressure? A) Clinical impression B) MRI C) Both D) Neither
D) Neither Clinical impression not good at all MRI high sens but only moderate spec JVIM 2020 Giannasi
50
Which can help predict mortality in dogs with TBI when measured at presentation? A) BG B) Modified Glasgow Coma Scale C) Both D) Neither
C) Both Nonsurvivors: --Higher BG (dogs only!) --Higher MGCS JVECC 2022 Cameron
51
15yr MN DSH with moderate PL ataxia and a shifting head tilt. His head tilts to the opposite side to which he is moving. What abnormality are you expecting on bloodwork?
Hypokalemia --> hypokalemic myopathy, positioning head tilt Should resolve with K+ supplementation JFMS 2023 Tamura
52
CVA in CATS vs DOGS: --Usually ischemic (clot) or hemorrhagic? --Usually idiopathic or underlying disease?
Both: ischemic Cats: usually underlying disease (HCM, pulmonary mass, hyperthyroid) Dogs: Half underlying disease (usually heart) JSAP 2022 Ozawa JFMS 2019 Whittaker
53
Frunevetmab: --What proportion of cats respond? --List a few side effects.
75% Derm stuff (alopecia, pruritus, etc) JVIM 2021 Gruen
54
What medication could act as a substitute for the tensilon test?
Neostygmine **Note -- still had a few false positives, but was safe to give pending AChR titer results JVECC 2021 Cridge
55
Muscle cramps: --Often triggered by? --Majority are due to? --Idiopathic in what breed?
Prompting dog to move Hypoparathyroidism GSDs JVIM 2020 Gagliardo
56
Common features of muscle stiffness in HAC dogs: --Dog size --Legs affected --Timing of dx relative to HAC --Improvement with trilostane? --Effect on survival time?
Almost all <20kg PLs >> all four > TLs After >> before >>> at the same time HAC signs improved as expected but not muscle stiffness. That usually persisted or progressed even with add'l therapies. None JVIM 2023 Golinelli
57
9mo FI Great dane with significant, high frequency tremors in all four limbs when standing. Goes away when she lays down. --Likely ddx? --Three tests to confirm? --Treatment and response rate?
Orthostatic tremor - rare movement disorder, mostly young large/giant breed dogs, can be idiopathic or secondary to other disease Resolution of tremors on weight bearing lifting test (WEBLT) EMG "Helicopter sign" (stethescope on tremoring leg sounds like a helicopter) Antiepileptics +/- gaba, 75% improve JVIM 2021 Liatis
58
2yr MI American staffordshire terrier with chronic inspiratory stridor. What hereditary condition is seen in this breed which could explain his CS? Prognosis?
Juvenile onset polyneuropathy - autosomal recessive Slow progression in most dogs, most able to maintain good QoL and ambulatory status Lar-par common, ME rare JVIM 2018 Vandenberghe
59
6mo FI Siberian cat with chronic, progressive, waxing/waning muscle weakness. On PE, her withdrawal reflex is decreased. What hereditary condition is seen in this breed which could explain her CS? Prognosis? If this had been a 10mo MN cat, what inflammatory disease would you consider? Dx, tx, px?
Juvenile onset motor polyneuropathy Will probably grow out of it by 1yr old. For episodes, can try onsior, pred, or benign neglect. Immune mediated polyneuropathy (affects motor axons only). Male > female, almost all <3yrs old. Dx - electrodiagnostics, muscle/nerve bx. Most recover (though a quarter go on to have more episodes), similar rate with or without steroids. JVIM 2020 Crawford JVIM 2023 Van Caenegem
60
3yr FS Sphynx with short (<5min) episodes of abnormal walking due to muscle stiffness in all four limbs. Seems like episodes may be triggered when she suddenly gets up, or is excited. What hereditary condition is seen in this breed which could explain her CS? One medication that may help? Prognosis? A similar condition is seen in what dog breed?
Paroxysmal dyskinesia Can try acetazolamide if you want, unclear if it helps since patients often go into spontaneous remission. Does not seem to affect QoL. Maltese JFMS 2022 James JVIM 2020 Polidoro
61
True or False: Trazodone does not affect neuro exams in dogs.
False - 20% of dogs will have new/worse postural deficits. Ideally don't give it. JVIM 2022 Lueck

DACVIM Literature 2018-2023 (13 decks)

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